Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Liu, Wen-Chih; Raasveld, Floris V.; Mayrhofer-Schmid, Maximilian; Eberlin, Kyle R.; Valerio, Ian L.

doi:10.1097/gox.0000000000005640

Plastic and Reconstructive Surgery - Global Open

2024

DOI: 10.1097/gox.0000000000005640

|View full text |Cite

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Wen-Chih Liu,

Floris V. Raasveld,

Maximilian Mayrhofer-Schmid

et al.

Abstract: Summary: Disposable handheld nerve stimulators are widely used in peripheral nerve surgery. Such devices stimulate a motor nerve or the motor component of a mixed nerve by applying electrical current to the proximal region, targeting the main nerve trunk. This stimulation then travels along the motor nerve, reaching the distal end to control the corresponding muscle(s). In this study, the authors demonstrate three useful tips and tricks for handheld nerve stimulation during targeted muscle reinnerv… Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2024

Publication Types

Select...

Article2

Relationship

Self Cite0

Independent2

Authors

Journals

Cited by 2 publications

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Pain Remission Following Delayed Targeted Muscle Reinnervation in Amputees

Raasveld,

Mayrhofer‐Schmid,

Johnston

et al. 2024

Microsurgery

View full text Add to dashboard Cite

IntroductionTargeted muscle reinnervation (TMR) has demonstrated efficacy for treatment of neuropathic pain. This study aims to identify patients for whom delayed TMR may be most effective and to identify associated factors for favorable pain outcomes in this patient population.MethodsAn analysis was conducted on prospectively enrolled amputee patients who underwent delayed TMR at a tertiary care center from 2017 to 2024. Data on demographics, comorbidities, surgical details, and pain outcomes were collected. Patient reported pain severity on a 0–10 scale was prospectively collected. The main pain outcome was pain remission (achieving the minimally clinically important difference (MCID)). Additionally, sustained mild pain (pain score ≤ 3/10 for ≥ 3 months), and pain disappearance (pain score 0/10 for ≥ 3 months) were assessed. Multivariable regression analyses identified factors influencing pain outcomes.ResultsOut of 101 patients included in this study, 64 patients (63.4%) achieved pain remission within a two‐year post‐operative period, and 37 patients (36.6%) did not. Sustained mild pain, which could be achieved in addition to pain remission, was achieved by 45.8% of patients, with 17.8% of these achieving complete pain disappearance. Patients achieving pain remission demonstrated lower pain over the entire post‐operative trajectory (p < 0.001). Lower pre‐operative pain scores, absence of depression, no pre‐operative opioid use, lower Elixhauser Comorbidity Index, and distal amputation levels were correlated with favorable outcomes following delayed TMR (p < 0.05).DiscussionPre‐operative pain severity, psychiatric comorbidities, and opioid use significantly influenced pain outcomes, emphasizing the need for comprehensive patient assessment. These findings will help with patient stratification and pre‐operative counseling to support patients who are best suitable for delayed TMR surgery.

show abstract

Pain Remission Following Delayed Targeted Muscle Reinnervation in Amputees

Raasveld,

Mayrhofer‐Schmid,

Johnston

et al. 2024

Microsurgery

View full text Add to dashboard Cite

show abstract

Reducing the Distance Between Anode and Cathode to Make Handheld Nerve Stimulators More Selective in Nerve Fascicle Selection: Report of Two Cases

Marina,

Sanz,

Cristobal

et al. 2024

Microsurgery

View full text Add to dashboard Cite

Precise nerve fascicle identification is important in certain peripheral nerve procedures. Although we believe bipolar nerve stimulation with intraoperative neuromonitoring is a superior method, many rely on clinical response evoked by handheld monopolar nerve stimulators. We present a modification in the use of the latter for a more precise fascicle stimulation. A 55‐year‐old man with a right high brachial plexus injury and a 47‐year‐old woman with a left median nerve schwannoma were scheduled for exploration and ulnar‐to‐musculocutaneous nerve transfer, and for surgical excision respectively. Intraoperatively, we used a disposable handheld monopolar nerve stimulator in an unorthodox way, placing the anode right next to the cathode (both touching the same nerve fascicle). In the first case, a fascicle that showed flexor carpi ulnaris (FCU) and intrinsic hand muscle contraction with standard stimulation (anode placed on patient's skin), showed only FCU activation with our modified method, and was chosen as donor. A BMC grade M4 elbow flexion was achieved 9 months after surgery. In the second case, safe schwannoma excision was performed after our modified stimulation technique caused thenar muscle activation in a single, unaffected fascicle, while standard monopolar stimulation showed activation in several fascicles. No unexpected motor/sensory deficits were noted during follow‐up. This report shows an easy modification in the use of handheld nerve stimulators that improves selectiveness when looking for nerve fascicles.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation

Cited by 2 publications

References 7 publications

Pain Remission Following Delayed Targeted Muscle Reinnervation in Amputees

Pain Remission Following Delayed Targeted Muscle Reinnervation in Amputees

Reducing the Distance Between Anode and Cathode to Make Handheld Nerve Stimulators More Selective in Nerve Fascicle Selection: Report of Two Cases

Contact Info

Product

Resources

About